Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis

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The management of asymptomatic severe and very severe aortic stenosis (AS) remains unestablished. This study aimed to investigate the clinical outcomes of severe versus very severe AS patients.


A single centre, retrospective cohort study.

Patients and Methods

The study retrospectively reviewed 108 conservatively treated patients with severe AS (a maximal jet velocity ≥4.0 m/s, or mean aortic pressure gradient (MPG) ≥40 mm Hg, or an aortic valve area (AVA) <1.0 cm2) and 58 patients with very severe AS (a maximal jet velocity ≥5.0 m/s, or MPG ≥50 mm Hg or an AVA <0.6 cm2). Clinical outcomes were compared between the two groups, considering the existence of symptoms.

Main Outcome Measures

All-cause mortality and valve-related event, defined by a composite of cardiac death and hospitalisation because of heart failure.


Mean follow-up was 5.5±3.1 years. Fifty-six patients (52%) with severe AS and 20 patients (34%) with very severe AS were asymptomatic. Very severe AS had poorer survival and valve-related event-free survival than severe AS at 3 years (77% vs 88%, p<0.01; 75% vs 88%, p<0.001, respectively). In addition, the 3-year survival and valve-related event-free survival of asymptomatic very severe AS were comparable with symptomatic severe AS, but they were significantly worse than asymptomatic severe AS (p<0.01 and p<0.001, respectively).


Surgery should always be considered in very severe AS regardless of symptoms, and particular attention needs to be paid to their extremely poor outcomes.

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